Abstract
Abdominal and general adiposity are independently associated with mortality, but there is no consensus on how best to assess abdominal adiposity. We compared the ability of alternative waist indices to complement body mass index (BMI) when assessing all-cause mortality. We used data from 352,985 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) and Cox proportional hazards models adjusted for other risk factors. During a mean follow-up of 16.1 years, 38,178 participants died. Combining in one model BMI and a strongly correlated waist index altered the association patterns with mortality, to a predominantly negative association for BMI and a stronger positive association for the waist index, while combining BMI with the uncorrelated A Body Shape Index (ABSI) preserved the association patterns. Sex-specific cohort-wide quartiles of waist indices correlated with BMI could not separate high-risk from low-risk individuals within underweight (BMI < 18.5 kg/m2) or obese (BMI ≥ 30 kg/m2) categories, while the highest quartile of ABSI separated 18–39% of the individuals within each BMI category, which had 22–55% higher risk of death. In conclusion, only a waist index independent of BMI by design, such as ABSI, complements BMI and enables efficient risk stratification, which could facilitate personalisation of screening, treatment and monitoring.
Highlights
Abdominal and general adiposity are independently associated with mortality, but there is no consensus on how best to assess abdominal adiposity
waist-to-hip ratio (WHR) was above the high-risk World Health Organisation (WHO) cut-offs in 76% of men and only 20% of women
After accounting for age at recruitment, individuals who died during each year showed consistently higher body mass index (BMI) compared to those who survived by the end of the same year only after the first seven years
Summary
Abdominal and general adiposity are independently associated with mortality, but there is no consensus on how best to assess abdominal adiposity. The European Prospective Investigation into Cancer and Nutrition (EPIC) was the first large study to confirm that both abdominal and general adiposity are independently associated with the risk of death and to recommend using a waist index in addition to BMI7. While general obesity is widely evaluated with body mass index (BMI)[8], according to the wellknown World Health Organisation (WHO) c ategories[9], there is no current consensus on how best to assess abdominal adiposity and various anthropometric indices incorporating waist circumference (WC) have been proposed in the literature[10,11,12,13,14,15,16]. In analogy to ABSI, an allometric Hip Index (HI) was developed as an independent of BMI alternative to hip circumference (HC), the traditional measure of gluteofemoral a diposity[34]
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